Supportive Care in Cancer

, Volume 26, Issue 9, pp 3297–3306 | Cite as

Predictors of attendance to an oncologist-referred exercise program for women with breast cancer

  • Kelcey A. Bland
  • Sarah E. Neil-Sztramko
  • Amy A. Kirkham
  • Alis Bonsignore
  • Cheri L. Van Patten
  • Donald C. McKenzie
  • Karen A. Gelmon
  • Kristin L. Campbell
Original Article



While exercise is associated with numerous benefits in women with breast cancer, adherence to exercise training concurrent to cancer treatment is challenging. We aimed to identify predictors of attendance to an oncologist-referred exercise program offered during and after adjuvant breast cancer treatment.


Women with early-stage breast cancer receiving chemotherapy (n = 68) enrolled in the Nutrition and Exercise During Adjuvant Treatment (NExT) study. Supervised aerobic and resistance exercise was prescribed three times per week during treatment, then one to two times per week for 20 additional weeks. Predictors of attendance were identified using multivariate linear regression for three phases of the intervention, including during (1) adjuvant chemotherapy, (2) radiation, and (3) 20-weeks post-treatment.


Higher baseline quality of life (QoL) predicted higher attendance during chemotherapy (β = 0.51%, 95 CI: 0.09, 0.93) and radiation (β = 0.85%, 95 CI: 0.28, 1.41), and higher QoL, measured at the end of treatment, predicted higher attendance post-treatment (β = 0.81%, 95 CI: 0.34, 1.28). Being employed pre-treatment (β = 34.08%, 95 CI: 5.71, 62.45) and a personal annual income > $80,000 (β = 32.70%, 95 CI: 0.85, 64.55) predicted higher attendance during radiation. Being divorced, separated or widowed (β = − 34.62%, 95 CI: − 56.33, − 12.90), or single (β = − 25.38%, 95 CI: − 40.64, − 10.13), relative to being married/common-law, and undergoing a second surgery (β = − 21.37%, 95 CI: − 33.10, − 9.65) predicted lower attendance post-treatment.


Demographic variables, QoL, and receipt of a second surgery significantly predicted attendance throughout the NExT supervised exercise program. These results may help identify individuals with exercise adherence challenges and improve the design of future interventions, including optimizing the timing of program delivery.


Breast neoplasm Adjuvant chemotherapy Radiation Exercise training Resistance training 


Funding information

This project was funded by the British Columbia Cancer Foundation.

Compliance with ethical standards

Conflicts of interest

The authors declare they have no conflicts of interest.


  1. 1.
    Fong DYT, Ho JWC, Hui BPH, Lee AM, Macfarlane DJ, Leung SSK et al (2012) Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ 30:344–e70Google Scholar
  2. 2.
    Speck RM, Courneya KS, Mâsse LC, Duval S, Schmitz KH (2010) An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv Res Pract. 4(2):87–100CrossRefGoogle Scholar
  3. 3.
    Lahart IM, Metsios GS, Nevill AM, Carmichael AR (2015) Physical activity, risk of death and recurrence in breast cancer survivors: a systematic review and meta-analysis of epidemiological studies. Acta Oncol Stockh Swed 54(5):635–654CrossRefGoogle Scholar
  4. 4.
    Cormie P, Zopf EM, Zhang X, Schmitz KH (2017) The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev 39(1):71–92CrossRefPubMedGoogle Scholar
  5. 5.
    Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL et al (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62(4):242–274CrossRefGoogle Scholar
  6. 6.
    van Waart H, Stuiver MM, van Harten WH, Geleijn E, Kieffer JM, Buffart LM et al (2015) Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial. J Clin Oncol Off J Am Soc Clin Oncol 33(17):1918–1927CrossRefGoogle Scholar
  7. 7.
    Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK et al. (2017) Effects and moderators of exercise on quality of life and physical function in patients with cancer: an individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev 52:91–104CrossRefPubMedGoogle Scholar
  8. 8.
    Sabate E (2003) Adherence to long-term therapies: evidence for action. World Health Organization, GenevaGoogle Scholar
  9. 9.
    Courneya KS, Segal RJ, Gelmon K, Reid RD, Mackey JR, Friedenreich CM et al (2008) Predictors of supervised exercise adherence during breast cancer chemotherapy. Med Sci Sports Exerc 40(6):1180–1187CrossRefPubMedGoogle Scholar
  10. 10.
    Courneya KS, Segal RJ, Gelmon K, Mackey JR, Friedenreich CM, Yasui Y et al (2014) Predictors of adherence to different types and doses of supervised exercise during breast cancer chemotherapy. Int J Behav Nutr Phys Act 11:85CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    McGuire R, Waltman N, Zimmerman L (2011) Intervention components promoting adherence to strength training exercise in breast cancer survivors with bone loss. West J Nurs Res 33(5):671–689CrossRefPubMedGoogle Scholar
  12. 12.
    Husebø AML, Karlsen B, Allan H, Søreide JA, Bru E (2015) Factors perceived to influence exercise adherence in women with breast cancer participating in an exercise programme during adjuvant chemotherapy: a focus group study. J Clin Nurs 24(3–4):500–510CrossRefPubMedGoogle Scholar
  13. 13.
    Swenson KK, Nissen MJ, Henly SJ (2010) Physical activity in women receiving chemotherapy for breast cancer: adherence to a walking intervention. Oncol Nurs Forum 37(3):321–330CrossRefPubMedGoogle Scholar
  14. 14.
    Huang H-P, Wen F-H, Tsai J-C, Lin Y-C, Shun S-C, Chang H-K, Wang JS, Jane SW, Chen MC, Chen ML (2015) Adherence to prescribed exercise time and intensity declines as the exercise program proceeds: findings from women under treatment for breast cancer. Support Care Cancer 23(7):2061–2071CrossRefPubMedGoogle Scholar
  15. 15.
    Kampshoff CS, Jansen F, van Mechelen W, May AM, Brug J, Chinapaw MJ et al (2014) Determinants of exercise adherence and maintenance among cancer survivors: a systematic review. Int J Behav Nutr Phys Act 11(1):80CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Husebø AML, Dyrstad SM, Søreide JA, Bru E (2013) Predicting exercise adherence in cancer patients and survivors: a systematic review and meta-analysis of motivational and behavioural factors. J Clin Nurs 22(1–2):4–21CrossRefPubMedGoogle Scholar
  17. 17.
    Ormel HL, van der Schoot GGF, Sluiter WJ, Jalving M, Gietema JA, Walenkamp AME. (2017) Predictors of adherence to exercise interventions during and after cancer treatment: a systematic review Psychooncology. doi:
  18. 18.
    Kirkham AA, Van Patten CL, Gelmon KA, McKenzie DC, Bonsignore A, Bland KA et al (2018) Effectiveness of oncologist-referred exercise and healthy eating programming as a part of supportive adjuvant care for early breast cancer. Oncologist 23(1):105–115CrossRefPubMedGoogle Scholar
  19. 19.
    Kirkham AA, Bonsignore A, Bland KA, McKenzie DC, Gelmon KA, Van Patten CL et al (2018) Exercise prescription and adherence for breast cancer: one size does not FITT all. Med Sci Sports Exerc 50(2):177–186CrossRefPubMedGoogle Scholar
  20. 20.
    Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM et al (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42(7):1409–1426CrossRefPubMedGoogle Scholar
  21. 21.
    Google (2017). Google maps. Accessed May 2017
  22. 22.
    Taylor HL, Jacobs DR, Schucker B, Knudsen J, Leon AS, Debacker G (1978) A questionnaire for the assessment of leisure time physical activities. J Chronic Dis 31(12):741–755CrossRefPubMedGoogle Scholar
  23. 23.
    Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR, Tudor-Locke C et al (2011) 2011 compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc 43(8):1575–1581CrossRefPubMedGoogle Scholar
  24. 24.
    Campbell KL, Foster-Schubert K, Xiao L, Alfano C, Bertram LC, Duggan C, Irwin M, McTiernan A (2012) Injuries in sedentary individuals enrolled in a 12-month, randomized, controlled, exercise trial. J Phys Act Health 9(2):198–207CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Ware JE (2000) SF-36 health survey update. Spine 25(24):3130–3139CrossRefPubMedGoogle Scholar
  26. 26.
    Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, Deasy S, Cobleigh M, Shiomoto G (1997) Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. J Clin Oncol Off J Am Soc Clin Oncol 15(3):974–986CrossRefGoogle Scholar
  27. 27.
    R Core Team. (2015) A language and environment for statistical computing. [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2015. Available from:
  28. 28.
    Santa Mina D, Alibhai SMH, Matthew AG, Guglietti CL, Steele J, Trachtenberg J et al (2012) Exercise in clinical cancer care: a call to action and program development description. Curr Oncol Tor Ont 19(3):e136–e144Google Scholar
  29. 29.
    Ligibel JA, Denlinger CS. New NCCN guidelines for survivorship care. (2013) J Natl Compr Cancer Netw JNCCN 11(5 Suppl):640–644Google Scholar
  30. 30.
    Latka RN, Alvarez-Reeves M, Cadmus L, Irwin ML (2009) Adherence to a randomized controlled trial of aerobic exercise in breast cancer survivors: the Yale exercise and survivorship study. J Cancer Surviv Res Pract 3(3):148–157CrossRefGoogle Scholar
  31. 31.
    Arem H, Sorkin M, Cartmel B, Fiellin M, Capozza S, Harrigan M et al (2016) Exercise adherence in a randomized trial of exercise on aromatase inhibitor arthralgias in breast cancer survivors: the Hormones and Physical Exercise (HOPE) study. J Cancer Surviv Res Pract. 10(4):654–662CrossRefGoogle Scholar
  32. 32.
    Pinto BM, Rabin C, Dunsiger S (2009) Home-based exercise among cancer survivors: adherence and its predictors. Psychooncology 18(4):369–376CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Courneya KS, Blanchard CM, Laing DM (2001) Exercise adherence in breast cancer survivors training for a dragon boat race competition: a preliminary investigation. Psychooncology 10(5):444–452CrossRefPubMedGoogle Scholar
  34. 34.
    Mohammad Ali S, Lindström M (2006) Psychosocial work conditions, unemployment, and leisure-time physical activity: a population-based study. Scand J Public Health 34(2):209–216CrossRefGoogle Scholar
  35. 35.
    McKee-Ryan F, Song Z, Wanberg CR, Kinicki AJ (2005) Psychological and physical well-being during unemployment: a meta-analytic study. J Appl Psychol 90(1):53–76CrossRefPubMedGoogle Scholar
  36. 36.
    Hong S, Bardwell WA, Natarajan L, Flatt SW, Rock CL, Newman VA et al (2007) Correlates of physical activity level in breast cancer survivors participating in the Women’s Healthy Eating and Living (WHEL) study. Breast Cancer Res Treat 101(2):225–232CrossRefPubMedGoogle Scholar
  37. 37.
    Milne HM, Wallman KE, Guilfoyle A, Gordon S, Corneya KS (2008) Self-determination theory and physical activity among breast cancer survivors. J Sport Exerc Psychol 30(1):23–38CrossRefPubMedGoogle Scholar
  38. 38.
    Statistics Canada (2017) Individuals by total income level, by province and territory (Canada) Accessed 3 March 2018
  39. 39.
    Pinto BM, Trunzo JJ, Reiss P, Shiu S-Y (2002) Exercise participation after diagnosis of breast cancer: trends and effects on mood and quality of life. Psychooncology 11(5):389–400CrossRefPubMedGoogle Scholar
  40. 40.
    Shang J, Wenzel J, Krumm S, Griffith K, Stewart K (2012) Who will drop out and who will drop in: exercise adherence in a randomized clinical trial among patients receiving active cancer treatment. Cancer Nurs 35(4):312–322CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kelcey A. Bland
    • 1
  • Sarah E. Neil-Sztramko
    • 2
  • Amy A. Kirkham
    • 3
  • Alis Bonsignore
    • 4
  • Cheri L. Van Patten
    • 5
  • Donald C. McKenzie
    • 6
  • Karen A. Gelmon
    • 5
  • Kristin L. Campbell
    • 1
    • 7
  1. 1.Rehabilitation SciencesUniversity of British ColumbiaVancouverCanada
  2. 2.Faculty of Health SciencesMcMaster UniversityHamiltonCanada
  3. 3.Department of Biomedical EngineeringUniversity of AlbertaEdmontonCanada
  4. 4.Toronto Rehabilitation InstituteUniversity of TorontoTorontoCanada
  5. 5.British Columbia Cancer AgencyVancouverCanada
  6. 6.School of KinesiologyUniversity of British ColumbiaVancouverCanada
  7. 7.Department of Physical TherapyUniversity of British ColumbiaVancouverCanada

Personalised recommendations